Thursday, December 4, 2008

Dr. Frederick Goodwin Responds to Carlat

Frederick Goodwin, who has been under fire from various quarters for apparently failing to disclose pharmaceutical company income to the producer of The Infinite Mind, has responded to my postings about this issue in the comments section of this blog entry. I thought it was an important enough response to feature it as its own post. I print it below in its entirety, and I will respond to his concerns in a separate entry. I was very saddened and disappointed to read Dr. Carlat’s post. While he and I may disagree on certain issues, I had always assumed that he adhered to minimum scholarly standards in his writings, standards that are expected of professionals with academic backgrounds.

While I was taken aback by the polemical over-the-top language from a colleague with whom I worked in a recent American Psychiatric Association symposium, e.g. “outrageous betrayal of the listeners trust,” I was most profoundly dismayed by statements that were simply not true. (And can easily be shown to be false.) For example, he said that “Goodwin brought together experts with clear financial interest in arguing for the drugs’ [SSRI’s] safety.” First, he ignored what I said in the statement that I had sent him before he posted this blog, namely, that the producer of the Infinite Mind, not the host, reserved for himself full responsibility for the selection of topics, selection of guests, preparation of the script, and even the questions to be asked.

If Dr. Carlat did not believe me, but still wanted to protect his own credibility, he easily could have checked this out with Mr. Lichtenstein, the show's producer, or I would have been happy to send him a copy of the contract which specifies the producer’s total control of content. The fact that he went ahead with his own version of reality, in the face of assertions to the contrary in his possession, (assertions which he apparently did not check out) is reminiscent of what the Times’ Gardiner Harris did in simply ignoring any reality that didn't fit his narrative.

(Incidentally the particular show that Dr. Carlat was discussing was put together in a hurry by Mr. Lichtenstein working alone because he wanted to get something on the air to reassure stations that he could still produce a new show now and then. I didn't even know who the guests were until I arrived at the studio and got the script that had been faxed directly to the radio station. Mr. Lichtenstein later acknowledged that he had not determined in advance that one of the guests was affiliated with a center getting funds from a pharmaceutical company. While this was not disclosed, as it should have been, it was an oversight by a vastly overworked producer. But that's a minor point.)

More damaging to Dr. Carlat's credibility is his loose throwing around of reckless charges referring to “experts with clear financial interests in arguing for the drugs’ [SSRI’s] safety.” Incidentally by referring to Zoloft in this context he seemed not to be aware that this drug has been available in a generic form for some time now. One would like to assume that the author of a pharmacology newsletter would be aware that once drugs become generic there is no further “promotion” by pharmaceutical companies and therefore no “clear financial interests” of anyone. His sweeping statement is more than naïve - it's recklessly damaging the reputation of distinguished academic scholars such as a professor at UCLA. Many of the readers of his blog may not understand how naïve it is to talk about “promotion” of a drug that's been off patent. Dr. Carlat must assume responsibility not only for misleading his readers, but also for recklessly and falsely damaging reputations. To use his phrase, “that's bad journalism.”

But he gets even more reckless. He asserts as fact that “ the segment itself was partially funded by Pfizer, the maker of Zoloft.” Where did he get this information? From a Scientology website? Unless Dr. Carlat can document this, he owes me, the Infinite Mind producer, the guests, and, especially his readers, an apology.

Dr. Carlat’s blog is, to use his own words, a “particularly outrageous betrayal of the [readers] trust,” readers who have a right to assume that his statements reflect the standards associated with professionals in academia.

I was taken aback by this response. I thought Dr. Goodwin should have consulted an attorney.

Would Dr. Goodwin advise that a psychiatrist seek to disprove to a paranoid patient that the FBI is beaming radar at his brain from the basement by conducting a thorough exploration of the basement with the patient?

Would he advise black folks to reply to a David Duke blog?

No fact will ever change the extreme views of Dr. Carlat, a biased, Harvard indoctrinated ideologue. Argument with such is delusion itself. In fairness to Harvard psychiatrists, their opinion of Dr. Carlat is privately expressed in quite inappropriate language.

I read this, and then read it again later in the day, and still come to the same conclusion: How does a physician get named in a Senate investigation regarding involvement with pharmaceutical organizations with an alleged fairly flagrant lack of transparency involving promoting information about research, diagnosing, and interventions; an investigation that has access to lots of information, and yet, the named party claims to be so innocent to then come across as a victim and then displace and deflect the charges onto someone who is just reporting the facts as read and experienced firsthand?

Here are three questions I doubt Dr Goodwin would answer here, much less anywhere else as he is involved in an action that could have significant consequences for his professional well being hereon, but I want to ask them and see who else agrees, or disagrees, with them asked:

1. How does a physician involved with a significant media outlet lose his job if he is not involved with some level of malfeasance?2. Why would someone with such public influence risk guilt by association by presenting guests on his show without insuring, to some responsible degree, the attendees are not promoting irresponsible or biased information in their involvement with sources that greatly benefit from said presentation?3. How does a responsible and credible physician get named in the first place in a US Senate investigation exposing allegations of a lack of transparency while being a significant source of information regarding health care assessments and interventions for both fellow colleagues and the general public?

I think the biggest question that should come out from this whole sordid affair, Dr Goodwin excluded for the moment, is when will doctors realize that there is a profound risk for loss of credibility and respect when accepting sizeable financial contributions from pharmaceutical organizations in this day and age?

The answer is easy for me: it is now, and it is unacceptable to defend it when you are trying to sell policy with alleged unbiased, objective research or standards of care when you are involved with someone or some organization who stands to greatly benefit financially from it.

This is not "health care", it is only "hurts care".

As I said 12 years ago in a letter to the editor, it is time to take the F-O-R out of profit in health care decisions. This may be just a silly quip, but I am tired of greedy idiots make my profession look silly.

Deeds, not words, are what defines you. We will find out if Dr Goodwin has a fine attorney to show the truth will exonerate him.

Or, will we read a future statement of apology to Dr Carlat if the outcome is otherwise? Don't hold your breath.

I will give Dr Goodwin some credit to at least make some statement publicly to Dr Carlat. Not like some of the other cowards named earlier who think their name alone should exonerate themselves by itself. Ego has no boundaries, eh?

I know we have vehemently disagreed with each other in the past but this is one of the best posts you have written in commentating on blogs. I liked this exert in particular:

"I think the biggest question that should come out from this whole sordid affair, Dr Goodwin excluded for the moment, is when will doctors realize that there is a profound risk for loss of credibility and respect when accepting sizeable financial contributions from pharmaceutical organizations in this day and age?"

I am floored that that concept is so hard for Dr. Goodwin and people in similar positions who have been snagged to understand. It is common sense for prominent professionals in all walks of life that you don't engage in activities that appear to be unethical much less being definitely that way.

Dr. Carlat, to his great credit, came to understand that, when he formerly a drug rep for Wyeth. Too bad, Dr. Goodwin didn't follow his lead.

In his time, Dr. Goodwin was the most cited author in psychiatry, a measure of his usefulness to others. Many of the other targets of the witch hunt are on this more recent list.

http://www.in-cites.com/scientists/psy-20-aug2006.html

And, Dr. Carlat was who?

This episode is part of the left wing ideologue witch hunt of biological psychiatry. Dr. Carlat is a collaborator with this attack by the enemies of clinical care. All enemies of clinical care and their running dogs will pay a heavy price.

It should start with legal actions. Start with Grassley. Sue him. Seek to pierce his unjust, unlawful, self-dealt legal immunity. Make him spend his time on his own survival. Do total forensic e-discovery on his records, and that of his entire staff. Publish the content to the web. To deter. To defend clinical care.

Next. Send the patients to visit his office. Put them on generic meds, the goal of this charade and witch hunt. Let Grassley see what the psychiatry of 1978 looks like.

"once drugs become generic there is no further 'promotion' by pharmaceutical companies and therefore no 'clear financial interests' of anyone."

I have seen brand-name meds promoted after they've gone off patent. I recall Valium print ads that promoted the "V" cut-out in the tablet as a post-patent selling point. Others try to hang onto market share with pitches like:"Go with the name patients trust." I still see Zoloft-branded tissue boxes in medical offices. They could be old, but there's no reason to assume Pfizer immediately stopped promoting its product as soon as generic competition appeared.

With Psych drugs, does it really matter if they are on patent or not? All pharma is concerned with is getting someone into the docs office. No one expects anyone to get well on these medications, only that they keep taking them.

"... is reminiscent of what the Times’ Gardiner Harris did in simply ignoring any reality that didn't fit his narrative."------Gardiner Harris is horribly biased against psychiatry and medication and should be moved to another beat....maybe "Psychodynamic Couch."

------This episode is part of the left wing ideologue witch hunt of biological psychiatry. ...

It should start with legal actions. Start with Grassley. Sue him. Seek to pierce his unjust, unlawful, self-dealt legal immunity. Make him spend his time on his own survival. Do total forensic e-discovery on his records, and that of his entire staff.

-------

You're exactly right: It is a left-wing witch-hunt. And I'm fairly on the left myself, but not to the point of irrationality.

"With Psych drugs, does it really matter if they are on patent or not? All pharma is concerned with is getting someone into the docs office. No one expects anyone to get well on these medications, only that they keep taking them."

------Who on earth thinks like this? Do you think people pay out the nose and tolerate side effects just because Big Pharma tells them???? This is just clueless.

I have known Dr. Goodwin for over 15 years and conducted research with him extensively. I have known Dr. Carlat personally for about 20 years. I like and respect them both, but I think we should focus on the policy issues. As Dan Carlat described, I invited them both to a symposium where this debate began. I invited them on purpose, so as to foster reasoned discussion, with the hope that we could get closer to consensus. My concern is that we need to get their views together, since the truth is not simply at one extreme or the other on this topic. I am posting my views on my blog http://blogs.psychologytoday.com/blog/mood-swings, where I have also posted my interpretation of this specific debate about Dr. Goodwin at http://blogs.psychologytoday.com/blog/mood-swings/200812/expert-or-shill-revisited. I do not think the media articles have done justice to Dr. Goodwin as a person or as a researcher. And I think Dr. Carlat's view that the Times just reported "the facts" misses the reality that there are many facts they did not report, or did not know, and thus invalid implications followed. I try to clarify these matters in my blog comment. I agree with critics, like Dr. Carlat, though, about the larger problem of cleaning up the pharmaceutical/academic medicine relationship.

My God Ms. Pera: How can you link Mr. Harris of the NY Times to psychodynamic psychiatry? There is not one word about psychoanalysis or psychodynamics in his entire article! You come across as not just a shill for biological psychiatry and its ethically-challeneged, swarthy surrogates, but also as someone who may have had a bad analysis/therapy! In the interest of full disclosure, FESS UP!

I haven't had bad psychotherapy, but the hundreds of people I know who have -- spending years in futile talk therapy when medication finally turned the key -- could fill a book! Well, actually, I only had room for one chapter.

The posting is about Dr Goodwin's response to Dr Carlat's challenge to responsible reporting and research. I don't get why comments here turn into attacks and get printed. Moderation is part of the blog process, so it validates the integrity of the site, or not.

Can we stay focused on the issues and not deflect or demean responsible debate, PLEASE!?

You are right, therapyfirst. I apologize to Ms. Pera. I stand by my comments regarding the content of Mr. Harris' article. But my shot about a bad therapy experience was out of line and deserved rebuke.